Z942 – Implantation or revision of stimulation pack or leads
OHIP Psychiatric Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
Implantation or revision of stimulation pack or leads. This is a surgical procedure listed under 'Procedures Involving Neural Elements' in the Spinal Surgical Procedures section of the Schedule of Benefits. The fee for the surgeon (suffix A) is a flat rate. Fees for assistant (suffix B) and anaesthetist (suffix C) are calculated based on basic units plus time units. The service has 6 base units for an assistant and 8 base units for anaesthesia.
When to Use
- Use Z942 for the initial surgical implantation of a spinal cord stimulator pulse generator or the surgical revision/replacement of existing leads.
- Select Z942 when performing a surgical revision of the stimulation pack (battery/generator) that requires an incision and surgical access, distinguishing it from simple non-invasive programming or interrogation.
Common Pitfalls
- Billing Z942 alongside other spinal procedures without ensuring the services are not considered 'inclusive' under the Schedule of Benefits, which can lead to automatic claim rejections.
- Failing to document the specific surgical nature of the revision, as simple lead adjustments performed percutaneously may be subject to different coding interpretations or audit scrutiny.
Billing Tips
- Ensure that the surgical assistant and anaesthetist units are calculated correctly using the 6 and 8 base units respectively, as these are specific to Z942 and differ from other spinal codes.
- If the procedure qualifies for after-hours premiums (E409/E410), ensure the start time is clearly documented in the operative report to support the 50% or 75% increase on the base fee.
Effective: April 1, 2025
Z. Spinal Surgical Procedures
SPINAL SURGICAL PROCEDURES
Surgical
Spinal Surgical Procedures
All insured services must be documented in appropriate records.
The record must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
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